<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('科室')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-office" data-rule="required" data-source="cyclopedia/office/index" data-field="type_name" class="form-control selectpage" name="row[office_id]" type="text" value="{$row.office_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recommend_h')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="cyclopedia/hospital/index" data-field="name" class="form-control selectpage" name="row[recommend_h]" type="text" value="{$row.recommend_h}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Overview')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-overview" class="form-control editor" rows="5" name="row[overview]" cols="50">{$row.overview|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Reason')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-reason" class="form-control editor" rows="5" name="row[reason]" cols="50">{$row.reason|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Symptom')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-symptom" class="form-control editor" rows="5" name="row[symptom]" cols="50">{$row.symptom|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Cure')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-cure" class="form-control editor" rows="5" name="row[cure]" cols="50">{$row.cure|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Prevent')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-prevent" class="form-control editor" rows="5" name="row[prevent]" cols="50">{$row.prevent|htmlentities}</textarea>
        </div>
    </div>
<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">{:__('Deteletime')}:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input id="c-deteletime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[deteletime]" type="text" value="{:$row.deteletime?datetime($row.deteletime):''}">-->
<!--        </div>-->
<!--    </div>-->

<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">{:__('Recommend_h')}:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input id="c-office" data-rule="required" data-field="name" data-source="cyclopedia/hospital/index" class="form-control selectpage" data-multiple="true"  name="row[recommend_h]" type="text" value="{$row.recommend_h}">-->
<!--        </div>-->
<!--    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">首字母:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-first_name" class="form-control" name="row[first_name]" type="text" value="{$row.first_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Weight')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-weight" class="form-control" name="row[weight]" type="number" value="{$row.weight|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
